Comparison of Intrathecal Morphine With the Quadratus Lumborum Type 2 Block for Post-operative Analgesia Following Elective Caesarean Section (QLBvITM Study)

NCT ID: NCT03267628

Last Updated: 2019-04-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-01

Study Completion Date

2019-12-31

Brief Summary

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The investigators are comparing post operative analgesia provided for caesarean section patients, with the quadratus lumborum type 2 block and intrathecal morphine.

Detailed Description

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In Australia the rate of birth via caesarean section (CS) has significantly increased over the last twenty years. Improvements in the care of women undergoing CS are important locally, nationally and internationally. Compared to women birthing vaginally, women undergoing CS experience more adverse events and more pain. Effective pain relief following CS is important as it enables early ambulation, encourages maternal bonding, and promotes breastfeeding initiation and establishment. Traditional analgesic techniques following CS include opioid medications. Whist effective, the use of opioids are associated with frequent and significant side effects. Alternative analgesic agents are being explored in an attempt to improve the effectiveness of pain relief available to women and clinicians.

The quadratus lumborum block (QLB) block is an innovative regional analgesic technique. Its role as an effective analgesic agent in abdominal surgery is increasing. However, it has not been studied for pain relief in Australia after cesarean section.

In this study, the investigator aims to compare post-operative analgesia and side effects between the QLB blocks versus adding morphine the participant's spinal anaesthetic (ITM) during the elective C/S. Results from this study will provide information on the analgesic impact of this new and emerging therapy and assist in the development of a larger clinical trial.

Conditions

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Cesarean Section Pain, Acute

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

4 groups of 25 patients each. All patients will receive a spinal and a quadratus lumborum type 2 block. The groups will have a combination of ITM / QLB or both or neither.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Double blinded

Study Groups

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Saline intrathecal as well as saline in Blocks

These 25 patients will receive 0.3ml saline added to the spinal anaesthetic and 25 ml saline both sides as a QLB2.

Group Type SHAM_COMPARATOR

Saline intrathecal as well as saline in Blocks

Intervention Type PROCEDURE

0.3 ml saline will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block.

Saline intrathecal as well as local anaesthetic in Blocks

Intervention Type PROCEDURE

0.3 ml saline will be added to the spinal anaesthetic. A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle.

Saline intrathecal as well as local anaesthetic in Blocks

These 25 patients will receive 0.3ml saline added to the spinal anaesthetic and 25 ml local anaesthetic both sides as a QLB2.

Group Type ACTIVE_COMPARATOR

Intrathecal morphine as well as local anaesthetic in Blocks

Intervention Type PROCEDURE

A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle. 150mcg morphine will be added to the spinal anaesthetic.

Saline intrathecal as well as saline in Blocks

Intervention Type PROCEDURE

0.3 ml saline will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block.

Intrathecal morphine as well as local anaesthetic in Blocks

These 25 patients will receive 0.3ml (150mcg) morphine added to the spinal anaesthetic and 25 ml local anaesthetic both sides as a QLB2.

Group Type ACTIVE_COMPARATOR

Intrathecal morphine as well as local anaesthetic in Blocks

Intervention Type PROCEDURE

A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle. 150mcg morphine will be added to the spinal anaesthetic.

Intrathecal morphine as well as saline in Block

Intervention Type PROCEDURE

150mcg morphine will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block.

Intrathecal morphine as well as saline in Block

These 25 patients will receive 0.3ml (150mcg) morphine added to the spinal anaesthetic and 25 ml saline both sides as a QLB2.

Group Type ACTIVE_COMPARATOR

Intrathecal morphine as well as saline in Block

Intervention Type PROCEDURE

150mcg morphine will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block.

Saline intrathecal as well as local anaesthetic in Blocks

Intervention Type PROCEDURE

0.3 ml saline will be added to the spinal anaesthetic. A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle.

Interventions

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Intrathecal morphine as well as local anaesthetic in Blocks

A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle. 150mcg morphine will be added to the spinal anaesthetic.

Intervention Type PROCEDURE

Intrathecal morphine as well as saline in Block

150mcg morphine will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block.

Intervention Type PROCEDURE

Saline intrathecal as well as saline in Blocks

0.3 ml saline will be added to the spinal anaesthetic. 25 ml saline will be used on each side during a quadratus lumborum type 2 block.

Intervention Type PROCEDURE

Saline intrathecal as well as local anaesthetic in Blocks

0.3 ml saline will be added to the spinal anaesthetic. A Quadratus lumborum type 2 block will be performed under ultrasound with 25 ml 0.375% ropivacaine deposited posterior to the quadratus lumborum muscle.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Anaesthetist trained in QLB and ITM techniques available
* American Society of Anaesthesiologists PS category client I or II
* 18 years of age or older
* Ability to read and understand English
* Uncomplicated pregnancy at term (\>37 weeks completed gestation)
* Booked elective CS

Exclusion Criteria

* Contraindications to spinal anaesthesia
* History of chronic opioid consumption / chronic pain conditions
* Known allergy to study drugs
* Weight more than 95kg or body mass index (BMI) more than 35 pre operative
* Placenta Previa / accreta
* Obstructive Sleep apnoea
* Severe asthma unable to tolerate Non steroidal anti inflammatory agents
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Sunshine Coast Hospital and Health Service

OTHER

Sponsor Role collaborator

Dr Willem Basson

OTHER

Sponsor Role lead

Responsible Party

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Dr Willem Basson

Staff Specialist in Anaesthetics

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Willem Basson, FANZCA

Role: PRINCIPAL_INVESTIGATOR

Sunshine Coast University Hospital

Other Identifiers

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HREC/17/QPCH/121

Identifier Type: -

Identifier Source: org_study_id

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